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United States health care system and the Military Health System (MHS) have long been faced with escalating health care cost. Implementing a managed care strategy, a system designed to integrate financing and delivery of appropriate health care services, has been viewed as the answer. As a result of implementing managed care, the MHS has transitioned from a workload-based financing methodology to a capitation methodology. Initially, the MHS implemented "modified capitation" financing. Effective FY-1998, the MHS began phasing-in the latest version of capitation, enrollment-based capitation (EBC). Under EBC, military treatment facility (MTF) Commanders' performance will be tracked and scored on an EBC Scorecard. The purpose of this thesis is to present a baseline assessment, describing new skills, roles and tools which comptrollers of Navy MTF are adopting to improve their MTF's performance under the indices of the EBC Scorecard.

This thesis explores the Defense Health Agency's (DHA) implementation and sustainment of the newly acquired electronic health record (EHR). The Military Health System (MHS) is utilizing a disjointed taxonomy of patient health record systems to deliver health services that are cumbersome to both the end users and the health information technology specialists in its use and delivery. The acquisition of the new commercial off-the-shelf EHR in 2016 from Cerner-Leidos-Accenture offers an enterprise solution to the MHS. This advanced IT solution requires detailed, deliberate implementation and deployment planning by the DHA, which will result in the effective, efficient, and economical delivery of healthcare services to Department of Defense personnel. Utilizing a case study approach, the authors conducted interviews at two sites within the DHA EHR deployment footprint and correlated results with the application and research of Kates and Galbraith's star model. The authors conclude that with appropriate change management efforts, communication of strategy and structure, measurement of metrics, and investment in people, the DHA has the ability to implement MHS GENESIS within reasonable schedule parameters and achieve equitable sustainment., http://archive.org/details/defensehealthage1094551700, Lieutenant, United States Navy;Lieutenant, United States Navy, Approved for public release; distribution is unlimited.

Escalating health care costs and base closures have forced the DoD to improve access to health care while maintaining quality, controlling costs, and increasing medical readiness. The response is a Tri-service managed care system called TRICARE. One mechanism utilized within the TRICARE Managed Care Support Contracts (MCSCs) is Resource Sharing. Resource sharing is a system to reduce the government's health care costs by recapturing the TRICARE workload This thesis explores if Resource Sharing Agreements (RSAs) are cost-effective and how they are being monitored and evaluated by the Lead Agent and MTFs. After conducting a literature review, interviews and performing data analysis, this thesis examined the reported cost analysis, retrospective analysis, and workload of RSAs in Health Services Region 10 as they are used under the MCSC for that region. A case study of RSAs, comparing forecasted and reported savings, was also conducted to understand RSAs and their role in controlling military health care costs. The analysis found that the RSAs are reducing government costs, but not at the predicted rate. This case study found that only 67 percent of the estimated government savings were realized. Decreasing workload is a key factor explaining this shortfall., http://archive.org/details/afinancialnalysi1094532649, Lieutenant, United States Navy, Approved for public release; distribution is unlimited.

Ad hoc, temporary solutions developed due to Service collaborations have overcome shortcomings in joint health services and increased the efficiency and effectiveness of operational medical support. According to the Joint Concept for Health Services (JCHS), the need for integrated medical support that keeps pace with the operational agility and organizational flexibility requirements to support globally integrated operations is clear. This research offers a review of the last major Department of Defense (DOD) transformation, which saw the Military Health System transition from three Service department medical commands to Service department medical commands with a Defense Health Agency (DHA), and relevant U.S. strategic doctrine. The goal of the research is to establish what the model of governance of the Military Health System should be. That, with other recommendations, should be the foundation for the impending transformation. The research found that the model of governance should be a single service model with regional health commands that support the geographic combatant commander (GCC). With an organization based on the presented model of governance, the Military Health System would be more efficient in accomplishing missions and tasks prescribed by the strategic documents.

A wealth of literature exists quantifying the benefits of clinical pharmacist optimization of a patient's medication therapy, but little literature exists codifying a model of clinical practice that allows for standardization and efficient staffing analysis. Essentially, the range of clinical pharmacy services is well described; however, the activities that comprise these services are not well documented. The purpose of this thesis was to develop a list of activities that comprise routine clinical pharmacy services for all inpatients in the military health system. Utilizing the Delphi method, an expert panel of six senior Army Pharmacy officers and civilians participated in a four round survey including one semi-structured interview and three successive rounds of Likert surveys. Panelist interview responses were reviewed for consistent themes, and their survey responses were analyzed for inter-round stability utilizing nonparametric statistics. A resultant list of fifteen clinical pharmacy activities reached the predetermined standard of consensus for inclusion in the list of activities that comprise routine clinical pharmacy services. These results were discussed in terms of their reliability and generalizability along with their implications for the development of future staffing models. Opportunities for future research building on the results of this study were suggested.

In the aftermath of large natural disasters inside the United States, the survivors of the affected area historically suffer for a protracted amount of time until outside help reaches the region. The Department of Defense and specifically the Army Medical Department is the only federal agency proven to possess the capacity to respond and alleviate the suffering of the injured, sick, and dying in the mangled remains of the devastated area. Within the ravaged area, a gap of pain develops in the time that elapses between the natural disaster and the arrival of external assistance. Historical examples such as Hurricane Andrew and Hurricane Katrina expose the appallingly slow, ad hoc, untrained, and ill-equipped initial response of Army Medical Department units. Active duty medical units require timely notification, integrated joint and civilian training, and specialized equipment to minimize the duration of suffering. This research seeks to determine the most effective way to employ the Army Health System's unique capabilities to assist the citizens of the United States in the aftermath of a natural disaster to reduce the gap of pain. The research examines the policy framework of the Defense Support to Civilian Authorities environment to determine the legal ways to employ active duty forces. Once determined, the research compares two similar case studies of Hurricanes Andrew and Katrina to derive the most effective way to employ the Army Health System. In each of the examples, a set of criteria, exposes the previous trends from the evidence and qualitatively compares the actions of each event to provide a foundation for recommendations. The criteria are the time it takes to respond to the disaster area, situational awareness to coordinate and integrate capabilities with jurisdictional authorities, and unit training and readiness to respond. The analysis of the evidence concludes there is a clear prerequisite to notify, train and equip specific medical units to execute t